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Changing lives with light – Helping children with disfiguring birthmarks

It’s hard to imagine but pulses of light can have a huge impact on the quality of life. Since the development of laser technologies, where light is used to heat a specific tissue and selectively destroy it, light has been used to treat millions children affected by disfiguring birthmarks such as congenital nevi (abnormal collection of pigmented cells) and port-wine stains (abnormal collection of blood vessels). The reason that light is so effective is that it can destroy only the cells or tissues that are targeted, while leaving the other healthy cells and tissues alone. These treatments are safe, effective and, in the correct hands, have no permanent side effects. Before selective laser treatments, surgery or radiation therapy were used, in Vietnam and other parts of Southeast Asia, children were still subjected to an outdated and dangerous treatment – radioactive phosphorus. A radioactive paste is applied to hemangiomas, which are a common skin growth in baby girls. This causes permanent scars, loss of skin pigment, destruction of hair and other normal skin structures, and an lifelong increase in the risk of skin cancers. Motivated by the desire to stop this dangerous practice and improve the lives of children, a group of Vietnamese and US physicians, namely Dr. Hoang Minh of the University of Medicine and Pharmacy of Ho Chi Minh City, Dr. Rox Anderson, Dr. Martin Mihm and Dr. Thanh-Nga Tran of Harvard Medical School, Dr. J. Stuart Nelson of the University of California, Irvine, and Dr. Thuy Phung of Texas Children’s Hospital, came together in 2009 to create the Vietnam Vascular Anomalies Center (Vietnam VAC), a non-profit organization dedicated to the use of light technologies to treat children with disfiguring birthmarks. Our goal was to create a permanent local clinic with modern laser and medical therapies, and to train physicians in Vietnam in the principles of safe and effective laser practices.

Credits: George Morgan

The center had its humble beginnings in a small room at Nguyen Tri Phuong Hospital with no air conditioning and only one piece of equipment–the Candela Vbeam Perfecta, a pulsed dye laser specific for vascular lesions, generously donated by the Syneron-Candela Corporation. On the first day of its operation, the clinic was flooded with over 500 patients from all over southern Vietnam who filled the hallway and courtyard of the hospital, awaiting treatment. We quickly realized that not only did Vietnamese children need better treatment for vascular birthmarks, but also other kinds of life-altering skin lesions such as malformations of veins or lymph vessels, pigmentation problems such as nevus of Ota and congenital nevi, Syneron-Candela Corporation donated two more lasers capable of helping these children (alexandrite lasers that target melanin, the primary pigment in hair and skin). Often, multiple lasers are required to treat complicated lesions such as congenital nevi that contain deep, abnormal pigment cells and hair follicles. We were fortunate enough to enlist the support of other companies including Lumenis, Lutronic, and Cutera corporations for additional lasers with different capabilities. For example, the Lumenis Ultrapulse fractional CO2 laser is capable of normalizing scars, which are common in Vietnam after burns or trauma. The scar treatment is specifically needed because there are many open fires in Vietnam with families living in close quarters, leaving children susceptible to scalding and burns. In addition, there is still a pervasive and horrifying practice of throwing acid onto the faces of jilted lovers or enemies. There are many patients with frozen joints and contracted scars, severely limiting movements. We embraced the opportunity to help children using lasers and modern medicines, regardless of the specific cause of their life-altering skin problem. In this way, the Vietnam Vascular Anomalies Center began to grow.

To prevent further damage to children with the continued use of radioactive phosphorus, we initiated a public health education campaign consisting of television documentaries, articles in scientific publications and influential local newspapers explaining the danger of this practice as well as alternative treatment options. In 2013, we were successful in convincing the Cancer Hospital in Ho Chi Minh City to abolish this dangerous practice and adopt modern treatment options. It was a proud moment for Vietnam VAC, which moved from its humble beginnings to having a seat at the University of Medicine and Pharmacy of Ho Chi Minh City as an official center, headed by Dr. Hoang Van Minh. A new office and operating room at Branch No 3 of the Hospital of the University of Medicine and Pharmacy, now houses the Vietnam VAC.

Credits: George Morgan

The problem of how to help children with severe scarring and depigmentation from radioactive phosphorus treatment remains. Dr. Rox Anderson, whose research introduced many modern laser technologies into medicine, together with Momelan Corporation (now KCI) created a new technology called fractional epidermal blister grafting, which is able to transfer normal epidermis to replace the mutated epidermis from radioactive phosphorus treatments. Small suction blisters are harvested from normal skin and then grafted onto the diseased skin after removal of its abnormal epidermis. We have successfully used this technologies combined with laser treatment to mitigate the effects of scarring and depigmentation on these unfortunate children. The results suggest that epidermal blister grafting may be applicable to other people with radiation damage, such as after treatment for breast cancer. This is an unexpected benefit from our work in Vietnam – by solving a problem unique to children in Southeast Asia, we have a new strategy to help others with radiation injury to the skin.

This month, Vietnam VAC celebrates 6 years of operation with a continuing medical education (CME) course and training session in Vietnam, culminating in a conference of over 500 physicians from all over Vietnam as well as the United States. This is a remarkable achievement for the Vietnamese team, led by Dr. Minh, who works tirelessly to make the center the largest and only VAC in Vietnam whose mission is compassionate clinical care, education, and research. With the leadership of Dr. Thuy Phung, a skin pathologist from Texas Children Hospital, Vietnam VAC has been improving the state of dermatopathology in Ho Chi Minh City, which started with only one doctor, an old microscope, and was using candle wax for embedding. We provided training for physicians in the United States, obtained donated equipment, and held courses in dermatology, laser medicine and pathology. For hemangiomas, safe laser and/or beta blocker drug treatment has replaced radioactive phosphorus treatment. Dr. Phung, who studies the mechanisms of hemangioma growth and treatments, teaches in both Vietnam and the US. Vietnam VAC also invited pediatric dermatologists and introduced alternative treatment for hemangiomas to the pediatricians at large in Ho Chi Minh City. Over the past 6 years, with partnership with laser companies and the generous support of many friends, donors and colleagues, the center has treated over 2,000 children on a free, safe, and effective basis.

Credits: George Morgan

So how does light change lives? In our case, it’s by alleviating the not-knowing and not-having through education, compassionate care, and humanitarian medical collaboration. We need no more validation than to hear a mother thanking us for having this clinic in Ho Chi Minh City because her daughter was about to have her arm amputated, and now has a normal arm after laser treatment. Instead of being ostracized or isolated from society due to major disfigurement, children and their families have a much more normal life. We hope to continue to expand our outreach to other parts of Vietnam including Can Tho and Da Nang so we can reach more disadvantaged children. The Vietnam VAC could be, and should be, a model for starting similar centers in other countries.

Light provides the energy for life on earth, and for powerful treatments. Just as one photon has a negligible impact while many can improve a child’s life, it takes many people working together to create and maintain the Vietnam VAC. Please read more about us at www.vietnamvac.org and keep abreast of what we do. We are grateful to be part of the International Year of Light and its mission to improve lives around the world.

Thanh-Nga Trinh Tran is cofounder of the Vietnam Vascular Anomalies Center, a non-profit humanitarian organization dedicated to the care of underserved children with vascular anomalies, pigmented birthmarks, scars and wounds. She obtained her doctorate from the Medical Engineering, Medical Physics program of the Harvard-MIT Division of Health Sciences and Technology. Thanks to her work, Dr. Trinh Tran has helped improve both education and patient outcomes for many children in developing countries.